I continue to be a fan of quality reporting from publications such as Physicians Practice, and I’ve cited their reports in several of my blog posts in the past. Today is no different. As regular reader here may know, I’ve spent a good bit of time on the subject of patient engagement, specifically how physicians and practice leaders can engage patients to improve their care outcomes and their health.
That brings me to a recent piece by Rosemarie Nelson titled, “Patient Portal: 6 Ways to Improve Patient Care.”
In the piece, Nelson discusses “meaningful use incentives, increased profitability or improved quality of care.” In exacting terms, she makes a call for patient portals and how it can get “patients engaged in their own care and satisfy just about any goal.”
Though I’m somewhat of a skeptic at the party for patient portals (I don’t think that in their current status they’ll actually lead the patient engagement charge), she offers six pretty interesting and solid tips for helping practices lighten their administrative loads.
Thanks, Rosemarie. It’s hard to argue these points:
Self-registration: “Invite and encourage patients to self-register on the portal. It will save your front-desk staff time, reduce costs, and patient data will be more complete and accurate. When patients call to schedule appointments use that time to introduce them to your patient portal, and explain that advance online registration will save them time on the day of their visit, because their paperwork will already be filled out. Advance registration on the portal provides your practice with three core requirements to meet meaningful use too.”
Collect patient data. “A tightly integrated or interfaced patient portal and EHR will deliver data back to the patient from their encounter. Push the patient’s medication list, medication allergies, problem list, and diagnostic test results from the EHR into the portal and patients almost naturally become more engaged in their healthcare.”
Report patient data. “There has always been a mystery surrounding that paper medical chart for patients. By delivering key components of their health information to them automatically, you can satisfy their curiosity and engage them in their own healthcare. As your nurse discharges the patient at the end of the office visit, use that discharge instruction time as an opportunity to introduce patients to the kind of information they will be able to find on the portal.”
Provide clinical summaries. “The integration/interface from the portal to the EHR allows for automation of data exchange after the patient visit. Clinical documentation is completed and made available to the patient without any action from your staff. In addition to further engaging patients in their own care, you’ll have achieved two more core requirements of meaningful use.”
Secure messaging. “Once you’ve got your patients using the portal to access information, you can begin to communicate with them via the secure online messaging function. Communicating online instead of on the telephone will streamline your practice operations significantly, even if all of your patients aren’t using the portal. Your staff can use the portal to deliver automatic reminders to patients regarding preventive care and/or follow-up care. No more manual logs or tickler files and no more mail merges to process. Developing HIPAA-compliant processes and standard messages frees up your staff to provide direct patient care.”
Provide patient education materials. “Secure messaging can also be used to direct each patient to educational information that is specific to their own individual needs and conditions. Your practice will achieve greater percentages of patients meeting quality measures and your patients will feel as well cared for as their pets. Three more requirements for meaningful use can be checked off, too.”
Well said, well said.
Meaningful use stage 2 is moving in the direction of patient engagement. The next phase in the federal incentive program sets the bar for it, but certainly doesn’t leave it here. Certainly, patients were part of stage 1, but now, they must take greater ownership of their care; probably one of the only ways we’ll actually see the needle move in regard to long-term health outcomes changes for the population.
Engagement of the patients, it is believed, will move all patients toward better choices and possibly healthier lifestyles, which obviously makes for a healthier population.
But given all of the rhetoric on the subject, and the fact that each of us is subjective, aren’t we really talking about something rather subjective?
Let me try to put it in terms that even I can understand: everyone talks about how patients must be more engaged – at the practice level, at the provider level and even at the vendor level (which is my belief) – but when it’s actually time to involve patients in their care, how is this done?
Well, one of the most popular answers is through social media sites like Facebook and Twitter. Bringing, or participating in, conversations about healthcare and interacting with patients online is considered to be a highly effective ways of reaching a broad audience, building a healthcare community, and educating and engaging patients.
But not everyone feels social media is the silver bullet. For example, I recently spoke with IDC Health Insights’ research director, Judy Hanover, who during our conversation said she thinks the healthcare community has become too infatuated with social media. She doesn’t see it as a truly effective means for engaging patients long term.
Certainly, social media has its place in building the physician/patient relationship, but its is limiting. Except for a very few people who like and want to share their personal health records online, most of us just don’t care to go into the specifics of our conditions in such a public forum.
So, the debate returns to healthcare information technology and the patient portal.
Online portals are designed to give patients anytime access to their health information. From a provider and vendor perspective, these tools have a great deal to do with meeting stage 2. For the patients, too, I suppose.
With the requirement that provider given patients access to online health information for viewing, downloading and transferring, and a second threshold requiring providers to push patient usage of this technology, it’s obvious the portal is a powerful player in this game.
I’ve written in the past about this issue and how the burden falls on the provider to engage patients through the portal to essentially secure incentive payments for stage 2.
Some do worry about their ability to meet the patient engagement requirement. I can imagine practices in rural areas or those that serve an older population may have some concerns.
Relying on a patient action to secure your incentive, especially after all of the work taken to meet the remainder of the MU requirements may seem like a blow to some. It would to me since my personality is one in which I like to have control of a project and not have to worry about outliers potentially derailing my progress (this sort of thing happens all of the time in school on group projects, right?)
So, how we do avoid this and encourage patients to use the portal?
What’s probably the best summation I’ve come across on the subject is in an interview Physicians Practice’s Aubrey Westgate conducted with Peter M. Kilbridge, a senior research director with The Advisory Board Company’s Information Technology. You can listen to it here.
Kilbridge’s perspective is valuable, and the tips he provides are easily accomplishable.
For example, to encourage use of the patient portal, practices should tell patients about it, and simply encourage them to use it and to talk about its capabilities. Highlight the portal’s capabilities, he says, and what it can do for patients and how it can make their live easier.
He says to highlight functions patients care about: viewing labs, sending questions, scheduling appointments. Follow it up by sending an email and paper mail reminder during about the upcoming visits or reminder
“Early success breeds confidence,” said Peter Kilbridge.
Still, the patients are truly empowered in stage 2, and all of the work invested on the part of the healthcare community might seem like it’s trivialized by the requirement needed to secure incentives.
This issue is being looked into, but currently there is no exception in place.
Is losing your incentive for stage 2 the price you’ll pay for lack of patient engagement? It certainly is a possibility?
Encouraging patient engagement at the practice level has gotten to be such a popular and all-encompassing subject in recent months that I’ve begun to see a great deal of editorial coverage dedicated to the topic.
In said pieces, columnists offers some practical advice to practice leaders for engaging their patients. Some of it is pretty much common sense while much of it just makes for good customer relations.
Perhaps what’s most telling, though, is that in the age of connectivity and mobility, where we are always on and part of one another’s lives because of technology and devices, it seems as if we have forgotten how to communicate with one another in a one-to-one, face-to-face environment.
My dad was a small business owner and I grew up in his shop. He wasn’t the most graceful individual, but he understood one thing: Without customers, we didn’t pay our bills and in a small town, a grouch was often on the outs and rarely part of the fold. The fact that he kept re-iterating that the customer was “always” right meant something. It stood for something and that “something” was that when our customers came to us they expected a certain level of service and to be treated with a great deal of respect.
He knew, as I do now, that the customer technically can’t “always” be right. It’s just not possible. You can make every concession possible to please your customers, but, in the end, there are going to be those that you can’t keep. And that’s okay.
But, when several editorials are written to coach us how patients should be engaged at the point of care, it’s easy to see that we certainly do live in a different time than even I can remember growing up in not so long ago.
That said here are a few tiny bits of sage advice I thought worthy of passing on.
According to Audrey McLaughlin’s recent post in Physicians Practice, “A great attitude in customer service can be very simple: Choose to be thankful for every patient that walks through your door, whether you are the receptionist, the nurse, the medical assistant, the doctor, office manager or bill collector. You must thank every person that comes in for choosing your medical practice. Let them know that you are grateful that they are there.”
McLaughlin should know. She’s an RN. She’s gained the following insights through experience, and given her confidence in these points, I assume she’s correct.
As she says, integrate an attitude of gratitude into all areas of the patient engagement including during appointment scheduling, telephone calls, check in and check out. Offering a sincere thank you goes a long way for stopping in or arriving on time will go a long way and can help set a positive tone for the visit.
If a patient is late for an appointment, a simple “Thanks for making it in,” goes a long way. But, as with all things that mean something, sincerity is key, she says. The sincerity should not end at the welcome desk, but should flow along through the exam room and back through to check out.
Start to finish, a patient should feel welcomed and appreciated, McLaughlin says.
But she’s not the only one saying such things. On the contrary, this seems to be a movement. Phil Colpas, editor of Health Management Technology recently posted his own blog entry on the same subject.
His take? A smiling staff means a healthier hospital. In his post, Colpas sites a recent study by the organization The Forum: Business Results through People, which states that “delivering better customer experiences starts with developing satisfied employees.”
As Colpas surmises, “In healthcare, the patients are the customers.” An astute observation, and quite true, even if often overlooked.
According to the report Colpas cites, “The Value of Achieving Organizational Health,” creating engaged employees increases employee productivity and customer satisfaction.
Healthcare leaders then, to find success, should (quoting Colpas), “Cultivate an environment that encourages employees to feel a part of and actively engage in the processes of patient care and meaningful-use compliance – and all that entails.”
Doing so should encourage a greater level of patient engagement, which is good for all and benefits not only the patient but the practice by driving future “sales” through increased word of mouth referrals, more return visits and patients that are likely to pay on time and invest more in their care.
The customer may not always be right, but making them feel like they are will go a long way toward building your practice into the success you want it to be.
It might take nothing more than a smile and some sincerity.
Any mention of money and people’s ears seem to perk. Work, for the money, on the other hand, seems to stifle a person’s desire to embark on the profitable journey.
“What’s that, you say? Money? Where?”
“Well, I’m glad you asked. By taking the following simple steps, by performing the following tasks, you might be able to save your practice time and money.”
The above over dramatization is courtesy of yours truly. Stellar dialogue, wouldn’t you say? Among my many talents. I’m actually a playwright. No, really. Published and everything.
Anyway, getting to the point, it seems that not matter where we turn, in this new healthcare environment where there seem to be opportunities for ‘49ers where ever you turn, someone is trying to tell you how to produce more profitability or efficiency for your practice.
Despite the zingers, there really are a few good pieces of advice out there that do seem to make sense, but, yes, you’ll need to put in a little time and work.
Here’s one example, courtesy of Carol Stryker and Physicians Practice magazine. According to Stryker, 30 percent of any activity is wasted. Thus, as she so eloquently writes, “The more useless labor you can eliminate, the bigger the increase in productivity and the fewer mistakes. A careful review of some or all of the processes in a medical office can generally be expected to yield productivity gains of at least 30 percent in the areas addressed.”
So, to eliminate wasted work and improve efficiency, which improves profitability, establish a process and iron out the wrinkles. The following six steps will help, she says.
1. Choose a process to streamline. One that is causing problems will most likely be easy to identify and will probably already will be taking your attention.
2. Answer this question, Stryker says: “What should the process accomplish and why is that important?” She encourages practice leaders to clearly identity the purpose and value of the process and write it down. “This is the yardstick for future evaluations. This is the only aspect of the project that the physician(s) cannot delegate or outsource,” she said.
3. Write down the steps to follow, in order. Once all the steps are documented, walk them through them to be certain you have not left anything out. Add what you left out and walk through again. Repeat until all steps have been captured.
4. For each step, ask the group: “What does this have to do with the goal?” If nothing, eliminate it. If not much, eliminate it or combine it with another step.
“Is another step performing the same function?” If so, which one produces the best outcome? Eliminate the less effective step.
“Is there a better way?” Do you have a tool, not available when the process was first developed, that gets the job done more effectively and/or efficiently?
“Could a step be added that would have a positive impact on a subsequent step?”
5. For the amended process, ask: “Are any additional steps necessary? If something will be printed now that was not printed before, what will be done with the paper?
“Are the steps in the most logical order?” Examine alternative sequencing as a possible improvement to the process.
“Is the process intuitive?” Will it be easy for the person doing the work to remember or to engage?
“Are any steps error-prone?” What can be done to eliminate error? If it can’t be done away with, what can be done to validate the step was done properly?
Repeat from Step 5 until satisfied with the proposed process.
6. Once the improved process is implemented, choose another process and repeat the analysis. Continue until satisfied with the way the office works.
According to Stryker, “The only difficulty is finding the time and discipline to perform an analysis of a process and implement improvements. Each successful project frees up resources and makes it easier to address another process. Morale improves because office operations are improving. Stress decreases because there is actually time to do what needs to be done. Staff turnover goes down and profits go up.”
And hopefully, once all of the steps in the process have been completed, you’ll find yourself with more time, a more efficient practice and you’ll identify ways to free up a little extra cash.